Request for Documentation of Restoration of Civil Rights

Name: ___________________________________________ NDOC #: _______________

Date of Birth: __________________________ SSN: _________-_____-________

Date Released from Incarceration (if known):____________________________________

Current Mailing Address: _____________________________________________________

________________________________________________________________________

Current Telephone No: (­­­­_____) ­­­­­­­­­­­­­­­­­___________________

Please provide me documentation of the restoration of my civil rights. I believe I am eligible for restoration of my civil rights because:

_____ I discharged my sentence before July 1, 2003.

_____ I have not been convicted of a Category A felony in Nevada or another state.

_____ I have not been convicted of a Category B felony with Substantial Bodily Harm in

Nevada or another state.

_____ I do not have two or more felony convictions in Nevada or another state.

DOC 2050 (8/06)